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HIV and Mental Health Gus Cairns, MA
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HIV and Mental Health
Gus Cairns, MA
Introduction To CourseAim of Training
• To educate and inform volunteers about aspects of HIV and mental health
• To help you discuss own experiences of dealing with clients with mental health and emotional support issues
• To help you deal with and relate to people with specific emotional support needs
The Day• Introductions
• Emotions and dealing with stress
• TEA BREAK
• Stress and HIV
• How stress may turn into dis-stress
• LUNCH
• Stigma and mental distress
• Diagnoses, definitions and types
• TEA BREAK
• Types of clients and issues they bring
• Issues for workers
• Evaluation and feedback
Activity
GROUP CONTRACTOR
LEARNING AGREEMENT
Guidelines…
• Confidentiality: Sharing the experience but not any identifying information
• Safety: respect others’ viewpoints, even if different from yours. They may have different experience
• Responsibility: take care of yourself, ask anything you want, say ‘no’ if you need to
Think about…
• Two or three feelings or problems that living with HIV, or working with people with HIV, gives you
Introductions
• Name
• What do you do?
• One sentence: why you work with HIV
• Two of the three problems you thought about just now
Four Primary Emotions
• Happiness
• Anger
• Fear
• Sadness…
• …and Confusion
Pair Exercise
“My bad day,
and what I did about it”
Activity
Flipchart Exercise
•Dealing with stress is self-therapy.
•Sometimes it’s good therapy, sometimes not so good!
Activity
BREAK
BREAK
A Side-Journey Into STRESS
• The state arising when the individual perceives that the demands placed on them exceed (or threaten to exceed) their capacity to cope, and therefore threaten their wellbeing.”*
• Stress is not mental illness• Stress is a normal part of life• Stress has physical effects• The result of stress depends on what you do with these physical
effects:
– To energise you– To give you ideas– To make you angry– To shut you up– To make you depressed– To make you ill
What problems cause stress to people with
HIV?
• Flipchart exercise
– Don’t have to be HIV-specific
StressEvent value
Death of spouse 100
Divorce 60
Menopause 60
Separation from living partner 60
Jail term or probation 60
Death of close family member other than spouse 60
Serious personal injury or illness 45
Marriage or establishing life partnership 45
Fired at work 45
Marital or relationship reconciliation 40
Stress Scale Top 10
HIV issues• Physical: HIV illness, dementia
• Drug side effects: Body changes
• New diagnosis
• Finance
• Housing
• Immigration status
• Stigma and isolation
• Disclosure
• Long term survivors: ‘Lazarus effect’: I’m not special any more
• Work and career
• Loss and bereavement
• Sex and love
• Life issues that may have let to HIV: depression, addictions, abuse, vulnerability
How common? London 2002"What do you need?" Survey, 2003
0
10
20
30
40
50
60
70
80
90
100
Depression Sleep Self confidence Relationships Drink andDrugs
Africans in England, 2003
Project Nasah Survey
Why do some people deal better with stress
than others?
Symptom Cycle…(From Positive Self-
Management Programme)
Gestalt Cycle (Fritz Perls, 1951)
A model for how we process experience: Mental ill-health is seen as an interruption/block in the cycle
A model for how we deal with adaptation to loss and change
On Death and Dying by Elisabeth Kübler-Ross
Fight, Flight or Freeze• Normal reaction to a threat (stress) is to fight it or
run away. Either is a way of controlling it
– Adrenaline mobilises the “Fight or flight” reaction
• When fight or flight a third option is possible – freeze.
– Acetylcholine produces relaxation
– In the presence of sympathetic arousal it produces dissociation – the “Freeze” reaction – like an animal playing dead
• Dissociation (“It’s not happening to me”) lies behind many adjustment disorders and ‘stuck’ states – see below.
– It doesn’t take control of the threat; just protects bodily functions while it’s happening
LUNCH
LUNCH
Quickfire list…
• Words or associations to do with mental illness
Put the emotions into the box
•See which box is fullest
•See which box is most empty
•You may have most problems with the emptiest box
•So may people with mental health problems
Activity
Definitions, Definitions…
• Organic: Dementia
• Psychosis
• Neurosis
• Personality Disorder
• A note on misdiagnosis
Five Primary Emotions - Stuck
• Happiness stuck ⇒ manic defence, denial
• Anger stuck ⇒ pathological rage, blame, self-harm, suicide
• Fear stuck ⇒ anxiety disorder, panic attacks, phobias, PTSD, OCD
• Sadness stuck depression, dysthymia, ⇒irritability, physical symptoms
• Confusion stuck more confusion (compound ⇒dissociation, fugue, DID, amnesia)
Yes ,but why do some people deal better with
stress than others?
Life scriptsfrom Body Psychotherapy and Transactional
Analysis.‘Stories’ we tell ourselves about life, gathered from early
experience. Different life scripts come from different types of deprivation in infancy
• LIFE MEANS NOTHING/IS IMPOSSIBLE UNLESS…
– “I am in control” – Schizoid type: Others’ control means death– “I please people” – Oral type – endlessly seeks (never finds) love– “I and s/he are in love” – Symbiotic type – Endlessly imagines love– “I am loved and adored” – Narcissistic type – needs fame/adoration– “I do it all myself” – Masochistic type – Help equals humiliation– “I am stimulated and excited” – Thrill-seeker: Ordinary equals
boring/alone– “I am a success” – Rigid type: Failure equals failure for all time– “I win” - Psychopathic type: And others fail!
BREAK
BREAK
What We Notice…• Appearance/behaviour: unkempt, restless, eccentric
• Rapport: are they with you?
• Speech: slow, fast, easy, reluctant, comprehensible
• Mood: euphoric, depressed, anxious, irritable, labile, blunted, incongruent
• Thought: block, incoherence, delusion, obsession
• Cognition: ability to understand and have concepts
• Body and perception: dizzy, spaced-out, cold sweat, heart, headache, noise
• Insight: self-awareness, including the awareness that something is wrong (if it is)
Depression and its Risk Factor, Suicide
• A story…Mr P
• Inner experience and meaning of depression: shutdown
• Language to watch out for: overt/sleep/going away/switch off/can’t cope
• Depressed people are helpless, hopeless…and annoying!
• How NOT to help a depressed person
Anger and its Risk Factor, Violence
• A story…Dave
• Inner meaning and experience: frustration and isolation
• Language and behaviour to watch out for
• How NOT to handle angry clients
Bully/Victim/Rescuer
• Looking after yourself…
• The roles people play…
• …and the roles they try to get you to play
Boundaries and Confidentiality
• The client who wants to be your friend
• The client who tells you shocking things
• When to break confidentiality
